Campaign: Report Cesarean Rates to the Public!



So you like having cesarean rates all complied on one site, I’ve noticed…

Me, too.

My friends Glen and Tara Elrod were in town and we wasted no time diving in and talking about all things maternity care. Glen, an OB in Wasilla, Alaska, asked what might be the most important question when it comes to cesarean rate reporting… why is it such a big deal for these to be formally reported? He’s exactly right. All of this should come from a reporting agency, not from Jill sitting at her kitchen table.

We talked about how there is absolutely no reason to stall on publicizing hospital cesarean rates and the government could easily use the administrative data that they already have for 44 states. Sure, risk-adjusted would be so much better, but why not just start by making total cesarean rates (total CS divided by total deliveries) public? Everything is de-identified and if there were less than a certain number performed, you simply don’t report on those hospitals to protect patient privacy, particularly in rural areas.

It really shouldn’t be a big deal. I know what the hold-up is after talking to 4,352,132 people and reading extensively on the topic. I’d like to charge forward and see what can we can collectively do about it.

But I’ve hit a brick wall. This is an all-volunteer project and the volunteer is me.

I’m going to need to go back in for another round of pulling numbers one by one from hospital association web sites or departments of health pages, because the entire point of the first phase of the site is to show the most current cesarean rates available to the public. If those lapse, which some have, then there’s really no point to keeping the site online.

I am ready to go on spreadsheet binges during which I live off the same block of cheese for a week and drink coffee and just put social skills and hygiene on hold for a while. Regular readers of this blog know that I am just a bit sarcastic, so many of them think I’m kidding. I’m not. I’m ready for those voice mails from friends telling me to “leave the house” and “put on pants” and “interact” with another “human being.” We all have our process. But it’s all gone so far past being able to justify the time I put into it. I was getting worked up about what I couldn’t do for my kids this summer and all of the things that it seems like people do and my mom, that scrappy little Buddha, paused and said dryly something to the effect of, “You know what your kids like, Jill? They like to be fed. So why don’t you focus on feeding your kids and not worry about whether they do x, y or z.”

She’s right. They also like health insurance and I like having it, too.

I really have sat here for long enough wondering how in the world I am going to make this project sustainable. There has been plenty of action (proposals submitted and such), so it’s not like I have just been staring out the window wondering about it all, trying to figure out how to fund at some of my time and cover big girl business expenses (Did you know that CPAs won’t work for in exchange for smiles and high-fives? That was news to me.). Lawyers won’t either! Side note: There is a now what I think qualifies as a running joke in the anything that deals with the out-of-hospital midwifery community about the expectation of working for no pay. It’s a vicious cycle of griping, then turning to someone from whom they want something and going apeshit with some guilt-bombs or aggressive posturing about how if you commoditize something, it’s not done with love, man. Bullshit. You just want something for free. Nice try, my womynsongmoonsister.

I keep sane by laughing about it all with a friend (Me: “Hey, the underside of my dog’s tongue looks like a piece of ahi sashimi.” Her: “Lucky. I can’t afford sashimi.”) who is also a single mother barely getting by but WHAT THE HELL SHE IS A DOCTOR NOW AND WORKS NIGHTS AT THE HOSPITAL AS AN INTERN AND HOW IS THAT EVEN POSSIBLE? Oddly, she says that she takes comfort in having a predictable life plan and doesn’t understand how I can just create stuff on the fly, which sort of blows my mind. I think she is just being nice.

I bounced some ideas off another friend, who finally asked me something like this (paraphrased):

Look, dumbass, have you ever considered that it looks professional enough to where people just assume it’s already funded?

Truthfully, I hadn’t really thought of it that way but it makes sense. I did this as research in conjunction with a presentation at the APHA Annual Meeting last October. I had some long-term goals and ideas for it, but the main thing was just completing the research, showing exactly what is available to the public and measuring if people were interested in seeing it. My favorite is that people think, as I used to, that Google ads pay big bucks. LOLZ. Big LOLZ to that. It’s about 100 bucks a month for both sites. I have been blessed beyond belief to get to work with Jim and Camilla, authors of The Pregnancy Power Workbook, this summer, by the way.

My lady consiglieri (and God bless their tolerance of my e-mails) suggested crowdfunding. Their feedback went something like this: If it’s a community that wanted and requested the information and work, you might as well ask them to help you keep it going as long as you can. Let the public decide how long can run. They decide and you just walk away and go work somewhere else if there is no interest. Work is work.


We worked on creating a fundraising campaign to get the absolute bare minimum of what it would take to justify this work through the end of the year. Partial funding is fine. If half of the amount comes in, I will be happy to keep things hopping until around the end of September or whatever the halfway mark is.

As I am prone to overexplaining, I thought I would publish this post about the campaign to explain it to my regular readers and fans and stalkers and critics or whatever you are. I am in a really good place of feeling satisfied with what has been accomplished here. I did the research. I presented it as a freaking layperson at the American Public Health Association Annual Meeting. I somehow managed to become the person with 97% of the information on cesarean rate reporting in the U.S. when the experts whom I consult never seem to have more than 85% of the overview of all of the datasets available and what the deal is with them. I could walk away with a smile and be proud of everything I have put into it.

So it’s on you all now. I’m available to do the research, the outreach, the communication with the public, the advocacy and the spreadsheet/graph binges. I’m even free to blow off steam by posting corny crap and vagina jokes on The Unnecesarean. Lucky, lucky you on that last one. Head on over. Check it out. I’m about to find out what I am doing for the next few months of my life and possibly through the end of the year. Like my dear friend, the single-mom doing her internship, it will be nice to have something of a plan and an idea of how far this will go. Thank you. Oh, and if you ever want to hear more about cesarean rate reporting, you should call me if you have an hour or two free because I think this is The Most Exciting Topic in the World and I think I may have pushed the limits of friends in my life who want to hear me get all amped up and chatty about it. I see signs that they are bored, but those signs don’t mean stop talking—they obviously mean I just am not being animated and loud enough! MOAR CESAREAN RATES AND HEALTHY POLICY FOR YOU RIGHT NOW!